Adolescent Behavior, Emotion Regulation, Risky Sexual Behavior
Conditions
Keywords
Risky Sexual Behavior, Emotion Regulation, Adolescent Behavior
Brief summary
Using the efficacious iTRAC intervention to enhance emotion regulation competencies as a foundation, this study will create and test iTRAC-HERO to teach emotion regulation skills in the context of sexual health education.
Detailed description
Adolescence is a critical developmental period during which behavioral patterns are formed that have powerful influences on current and future health. This is particularly true for sexual behavior, which is affected by the biological changes of puberty as well as normative developmental tasks around sexual exploration. Engaging in sexual behavior in early adolescence (before age 15) is associated with more partners, less condom use, and more frequent sex as teens get older, and these factors increase risk for negative health outcomes (e.g., sexually transmitted infections and unplanned pregnancy) throughout their lives. Many sexual health interventions teach prevention skills, such as assertiveness or condom use; the premise of the current application is that these skills are often unused by adolescents because of deficits in emotion regulation (ER), which is unaddressed in most sexual health education. Our research team has developed and tested a novel, engaging, efficacious, and developmentally tailored group intervention (Project TRAC) to teach ER skills to early adolescents within the context of sexual health. A study of Project TRAC showed that participants taught ER skills were less likely to start having sex over the 2.5 year follow up. While efficacious, the small group format of the Adolescence is a critical developmental period during which behavioral patterns are formed that have powerful influences on current and future health. This is particularly true for sexual behavior, which is affected by the biological changes of puberty as well as normative developmental tasks around sexual exploration. Engaging in sexual behavior in early adolescence (before age 15) is associated with more partners, less condom use, and more frequent sex as teens get older, and these factors increase risk for negative health outcomes (e.g., sexually transmitted infections and unplanned pregnancy) throughout their lives. Many sexual health interventions teach prevention skills, such as assertiveness or condom use; the premise of the current trial is that these skills are often unused by adolescents because of deficits in emotion regulation (ER), which is un-addressed in most sexual health education. The research team has developed and tested a novel, engaging, efficacious, and developmentally tailored group intervention (Project TRAC) to teach ER skills to early adolescents within the context of sexual health. A study of Project TRAC showed that participants taught ER skills were less likely to start having sex over the 2.5 year follow up. While efficacious, the small group format of the program presents barriers to sustainability and dissemination; significant advantages of web-based delivery exist. To explore whether the ER concepts of TRAC could be taught in a web-based format, the investigators completed a pilot study to translate TRAC's ER content to a web-based intervention (iTRAC), using Designing for Dissemination principles that enhance the likelihood of successful dissemination upon completion. iTRAC demonstrated feasibility and acceptability, and a randomized trial showed that iTRAC participants reported significantly better emotional competence compared to waitlist control participants. This study will complete the technology adaptation of the program to include its sexual health content and content linking ER to sexual health. This phase will create iTRAC-HERO as a web app. Once completed, acceptability testing will be completed with early adolescents to allow for modifications based on participant feedback. Once finalized, a small RCT will assess impact on adolescents' self-efficacy for preventing sexual risk as well as engagement in sexual behaviors.
Interventions
BEHAVIORALiTRAC-HERO
iTRAC-HERO will consist of eight, approximately 45-minute, "gamified" digital modules of 4-6 activities (games, videos, etc.). No instruction is needed to use the program. Content will use gender- and sexuality-inclusive language and avoid heteronormative descriptions of risk. This content will include strategies for (and practice with) recognizing and managing emotions, particularly in relation to sexual health situations, to enhance the likelihood that the emotion regulation and sexual health education provided can be applied to experiences that are emotionally arousing and lead to risk.
Sponsors
Klein Buendel, Inc.
Eunice Kennedy Shriver National Institute of Child Health and Human Development (NICHD)
Rhode Island Hospital
University of Oregon
Study design
Allocation
RANDOMIZED
Intervention model
PARALLEL
Primary purpose
PREVENTION
Masking
NONE
Intervention model description
Waitlist Control Trial
Eligibility
Sex/Gender
ALL
Age
12 Years to 14 Years
Healthy volunteers
No
Inclusion criteria
* Attending 7th grade * Between 12 and 14 years old * Parent/guardian speaks English or Spanish * Attending participating school
Exclusion criteria
* Unable to read at a 4th grade level * Have a sibling who has participated in the study * Have a development disorder
Design outcomes
Primary
| Measure | Time frame | Description |
|---|---|---|
| Change in Sexual Self-Efficacy (SSE) from baseline to 6 months. | Baseline, 1 month post-intervention, 6 month follow up | The Sexual Self-Efficacy Scale (12 items) will measure self-efficacy for safer sexual activity as a main outcome which will indicate iTRAC-HERO's efficacy and ability to promote healthier sexual behaviors with the full sample (not just those who are sexually active). |
| Change in Self Efficacy for HIV Prevention from baseline to 6 month. | Baseline, 1 month post-intervention, 6 month follow up | The Self-Efficacy for HIV Prevention Scale (12 items) assesses a range of behaviors related to prevention of HIV, other STIs, or unintended pregnancy, including refusing sexual behaviors, discussing sexual histories with partners, buying condoms, taking free condoms, carrying condoms, and asking a partner to use a condom. |
Secondary
| Measure | Time frame | Description |
|---|---|---|
| Change in Sexual Risk Cognition from baseline to 6 months | Baseline, 1 month post-intervention, 6 month follow up | The Sexuality Questionnaire for Adolescents (34 items) is a multiple choice test to assess sexual health knowledge and has been shown to be sensitive to intervention impact. |
| Change in attitudes towards abstinence from baseline to 6 months | Baseline, 1 month post-intervention, 6 month follow up | The Abstinence Attitudes questionnaire assesses agreement with values related to abstinence (α= .86). |
| Change in frequency of sexual and substance use behaviors from baseline to 6 months | Baseline, 1 month post-intervention, 6 month follow up | The Adolescent Risk Behavior Assessment (ARBA) will assess sexual behavior, including behaviors relevant to this developmental period. |
| Change in adolescent substance use behaviors from baseline to 6 months | Baseline, 1 month post-intervention, 6 month follow up | Youth Risk Behavior Surveillance System items will be used to assess tobacco/vape use, violence (e.g., fighting), and substance use behaviors. |
Countries
United States
Contacts
CONTACTJulia Berteletti
PRINCIPAL_INVESTIGATORChristopher Houck, PhD
Rhode Island Hospital
Outcome results
None listed